Comparing the Efficacy and Safety of Dexmedetomidine-Lidocaine and Propofol-Fentanyl-Midazolam Combinations during Endoscopic Retrograde Cholangiopancreatography

Background: Propofol is commonly used for providing sedation in endoscopic retrograde cholangiopancreatography (ERCP). It’s simple to use and effective but presents cardiovascular and respiratory adverse effects. Recently, dexmedetomidine has been tried but very little evidence exists to support its use. The aim of this study was to compare the efficacy and safety of combination of dexmedetomidine and lidocaine (DL) with the standard propofol-fentanyl (PF) regimen. Materials and Methods: After approval of the hospital ethics committee, 63 patients (18-60 years of age) were randomly divided into 2 groups. Thirty-one patients received a PF combination (group PF), and 32 patients received DL combination (group DL). The level of sedation was adjusted to achieve a Ramasy Sedation Scale (RSS) score of 3 (moderate sedation) in both groups of patients. Arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) during ERCP and recovery was continuously assessed. Results: The oxygen saturation (SpO2) showed high statistical significant differences between both groups throughout the procedure with stability in DL group (p 0.01). There was no statistical difference in HR and MAP between the two groups (p 0.05). Post-procedural recovery time was significantly shorter in PF group (15.97±3.27 min) compared with (19.38±5.64 min) DL group (p 0.01). PONV was 3.2% in PF group, while it was absent in DL group. No drug adverse effect or cardiovascular complications were observed in both groups. Conclusion: Dexmedetomidine and lidocaine combination as total intravenous anesthesia (TIVA) during ERCP not only did not reported any oxygen desaturation (SpO2 90%) but also showed better stability of oxygen saturation (SpO2) and less PONV when compared with propofol and fentanyl combination.